Half Of U.S. Patients Can Access Obamacare's 'Accountable Care Organizations'

Bruce Japsen
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More than half of the U.S. population now has access to emerging medical care delivery systems known as “accountable care organizations” (ACOs), which reward doctors and hospitals for working together to improve quality and controlling costs, according to a new analysis by consulting firm Oliver Wyman. (Photo credit: Wikipedia)

More than half of the U.S. population has access to emerging medical care delivery systems known as “accountable care organizations” (ACOs), which reward doctors and hospitals for working together to improve quality and to control costs.

The latest analysis from consulting firm Oliver Wyman says more than half of the U.S. population lives in “localities served by ACOs,” which link medical care providers together to improve quality. If the providers in the ACO achieve better outcomes, they divvy up money saved with the health plans.

“Over time, patients should notice that care gets more convenient, more proactive, and more effective,” said Rick Weil, a partner in Oliver Wyman’s Health & Life Sciences practice group. “For many people receiving care from one of these mixed-model ACOs, the shift to full participation in value-based care will be gradual and subtle as the contracts between the ACO and their insurance company migrate to ACO-style contracts.”

Between 37 million and 43 million patients, or about 14 percent of the U.S. population, are now in “organizations with ACO arrangements,” up from Oliver Wyman’s previous estimate last fall of between 25 million and 31 million, or about 10 percent of the population.

ACOs last year began providing medical care services to seniors through contracts with the Medicare health insurance program for the elderly. In addition, most private health insurance companies, too, such as those operated by Aetna (AET), Cigna (CI), Humana (HUM) and UnitedHealth Group (UNH) as well as Blue Cross plans linking with ACOS to care for more patients.

A health plan contracts with doctors and hospitals through an ACO which pushes high quality, less expensive treatment rather than today’s payment system that often leads to excessive treatment by paying for each procedure that isn’t always necessarily better. The providers in an ACO are responsible for managing the care of the health plan enrollees and are financially rewarded if the enrollees, or patients, stay out of the more expensive hospital.

Though it’s unclear exactly how many ACOs contracting with private health plans, the federal government has approved nearly 260 ACOs in the “Medicare Shared Savings Program,” an initiative under the Affordable Care Act. And Oliver Wyman consultants say their figures in their analyst are based on the latest ACO figures from the U.S. Department of Health and Human Services.

“With the latest additions, more than half of the population -- 52 percent -- lives in primary care service Areas served by ACOs, up from 45 percent this past August,” said Niyum Gandhi, an associate partner at Oliver Wyman. “The competition between ACO-based healthcare providers and traditional fee-for-service providers should give reform a good push forward.”